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The following is a guest blog post by Mike Semel, President of Semel Consulting. As a Healthcare Scene community, our hearts go out to all the victims of this tragedy.

Orlando Mayor Buddy Dyer said the influx of patients to the hospitals created problems due to confidentiality regulations, which he worked to have waived for victims’ families.

“The CEO of the hospital came to me and said they had an issue related to the families who came to the emergency room. Because of HIPAA regulations, they could not give them any information,” Dyer said. “So I reached out to the White House to see if we could get the HIPAA regulations waived. The White House went through the appropriate channels to waive those so the hospital could communicate with the families who were there.” Source: WBTV.com

I applaud the Orlando Regional Medical Center for its efforts to help the shooting victims. As the region’s trauma center, I think it could have done a lot better by not letting HIPAA get in the way of communicating with the patients’ families and friends.

In the wake of the horrific nightclub shooting, the hospital made things worse for the victim’s families and friends. And it wasn’t necessary, because built into HIPAA is a hospital’s ability to share information without calling the President of the United States. There are other exemptions for communicating with law enforcement.

The Orlando hospital made this situation worse for the families when its Mass Casualty Incident (MCI) plan should have anticipated the situation. A trauma center should have been better prepared than to ask the mayor for help.

As usual, HIPAA got the blame for someone’s lack of understanding about HIPAA. Based on my experience, many executives think they are too busy, or think themselves too important, to learn about HIPAA’s fundamental civil rights for patients. Civil Rights? HIPAA is enforced by the US Department of Health & Human Services’ Office for Civil Rights.

HIPAA compliance and data security are both executive level responsibilities, although many executives think it is something that should get tasked out to a subordinate. Having to call the White House because the hospital didn’t understand that HIPAA already gave it the right to talk to the families is shameful. It added unnecessary delays and more stress to the distraught families.

Doctors are often just as guilty as hospital executives of not taking HIPAA training and then giving HIPAA a bad rap. (I can imagine the medical practice managers and compliance officers silently nodding their heads.)

“HIPAA interferes with patient care” is something I hear often from doctors. When I ask how, I am told by the doctors that they can’t communicate with specialists, call for a consult, or talk to their patients’ families. These are ALL WRONG.

I ask those doctors two questions that are usually met with a silent stare:

When was the last time you received HIPAA training?

If you did get trained, did it take more than 5 minutes or was it just to get the requirement out of the way?

HIPAA allows doctors to share patient information with other doctors, hospitals, pharmacies, and Business Associates as long as it is for a patient’s Treatment, Payment, and for healthcare Operations (TPO.) This is communicated to patients through a Notice of Privacy Practices.

HIPAA allows doctors to use their judgment to determine what to say to friends and families of patients who are incapacitated or incompetent. The Orlando hospital could have communicated with family members and friends.

Does the HIPAA Privacy Rule permit a hospital to inform callers or visitors of a patient’s location and general condition in the emergency room, even if the patient’s information would not normally be included in the main hospital directory of admitted patients?

Answer: Yes.

If a patient’s family member, friend, or other person involved in the patient’s care or payment for care calls a health care provider to ask about the patient’s condition, does HIPAA require the health care provider to obtain proof of who the person is before speaking with them?

Answer: No. If the caller states that he or she is a family member or friend of the patient, or is involved in the patient’s care or payment for care, then HIPAA doesn’t require proof of identity in this case. However, a health care provider may establish his or her own rules for verifying who is on the phone. In addition, when someone other than a friend or family member is involved, the health care provider must be reasonably sure that the patient asked the person to be involved in his or her care or payment for care.

Can the fact that a patient has been “treated and released,” or that a patient has died, be released as part of the facility directory?

Answer: Yes.

Does the HIPAA Privacy Rule permit a doctor to discuss a patient’s health status, treatment, or payment arrangements with the patient’s family and friends?

Answer: Yes. The HIPAA Privacy Rule at 45 CFR 164.510(b) specifically permits covered entities to share information that is directly relevant to the involvement of a spouse, family members, friends, or other persons identified by a patient, in the patient’s care or payment for health care. If the patient is present, or is otherwise available prior to the disclosure, and has the capacity to make health care decisions, the covered entity may discuss this information with the family and these other persons if the patient agrees or, when given the opportunity, does not object. The covered entity may also share relevant information with the family and these other persons if it can reasonably infer, based on professional judgment, that the patient does not object. Under these circumstances, for example:

A doctor may give information about a patient’s mobility limitations to a friend driving the patient home from the hospital.

A hospital may discuss a patient’s payment options with her adult daughter.

A doctor may instruct a patient’s roommate about proper medicine dosage when she comes to pick up her friend from the hospital.

A physician may discuss a patient’s treatment with the patient in the presence of a friend when the patient brings the friend to a medical appointment and asks if the friend can come into the treatment room.

Even when the patient is not present or it is impracticable because of emergency circumstances or the patient’s incapacity for the covered entity to ask the patient about discussing her care or payment with a family member or other person, a covered entity may share this information with the person when, in exercising professional judgment, it determines that doing so would be in the best interest of the patient. See 45 CFR 164.510(b).

Thus, for example:

A surgeon may, if consistent with such professional judgment, inform a patient’s spouse, who accompanied her husband to the emergency room, that the patient has suffered a heart attack and provide periodic updates on the patient’s progress and prognosis.

A doctor may, if consistent with such professional judgment, discuss an incapacitated patient’s condition with a family member over the phone.

In addition, the Privacy Rule expressly permits a covered entity to use professional judgment and experience with common practice to make reasonable inferences about the patient’s best interests in allowing another person to act on behalf of the patient to pick up a filled prescription, medical supplies, X-rays, or other similar forms of protected health information. For example, when a person comes to a pharmacy requesting to pick up a prescription on behalf of an individual he identifies by name, a pharmacist, based on professional judgment and experience with common practice, may allow the person to do so.

Other examples of hospital executives’ lack of HIPAA knowledge include:

Shasta Regional Medical Center, where the CEO and Chief Medical Officer took a patient’s chart to the local newspaper and shared details of her treatment without her permission.

NY Presbyterian Hospital, which allowed the film crew from ABC’s ‘NY Med’ TV show to film dying and incapacitated patients.

To healthcare executives and doctors, many of your imagined challenges caused by HIPAA can be eliminated by learning more about the rules. You need to be prepared for the 3 a.m. phone call. And you don’t have to call the White House for help.

About Mike Semel
Mike Semel, President of Semel Consulting, is a certified HIPAA expert with over 12 years’ HIPAA experience and 30 years in IT. He has been the CIO for a hospital and a K-12 school district; owned and managed IT companies; ran operations at an online backup provider; and is a recognized HIPAA expert and speaker. He can be reached at mike@semelconsulting.com or 888-997-3635 x 101.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The following is a guest blog post by Jennifer Bergeron, Learning and Development Manager at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.

If you’ve ever traveled to a country that doesn’t speak your native tongue, you can appreciate the importance of basic communication. If you learn a second language to the degree that you’re adding nuance and colloquialisms, you’ve experienced how much easier it is to explain a point or to get answers you need. What if you’re expected to actually move to that foreign country under a strict timeline? The pressure is on to get up to speed. The same can be said for learning the detailed coding language of ICD-10.

The healthcare industry has been preparing in earnest to move from ICD-9 coding to the latest version of the international classification of diseases. People have been training, testing and updating information systems, essentially packing their bags to comply with the federal mandate to implement ICD-10 this October — but the trip was postponed. On April 1, President Barrack Obama signed into law a bill that includes an extension for converting to ICD-10 until at least Oct. 1, 2015. What does this mean for your ICD-10 travel plans?

Despite the unexpected delay, you’ll be living in ICD-10 country before you know it. With at least another year until the deadline, the timing is just right to start packing and hitting the books to learn the new codes and to prepare your systems. For those who have a head start, your time and focus has not gone to waste, so don’t throw your suitcases back into the closet. The planning, education and money involved in preparation for the ICD-10 transition doesn’t dissolve with the delay – you’ve collected valuable tools that will be put to use.

Although many people, including myself, are disappointed in the change, we need to continue making progress toward the conversion; learning and using ICD-10 will enable the United States to have more accurate, current and appropriate medical conversations with the rest of the world. Considering that it is almost four decades old, there is only so much communication that ICD-9 can handle; some categories are actually full as the number of new diagnoses continues to grow. ICD-9 uses three to five numeric characters for diagnosis coding, while ICD-10 uses three to seven alphanumeric characters. ICD-10 classifications will provide more specific information about medical conditions and procedures, allowing more depth and accuracy to conversations about a patient’s diagnosis and care.

Making the jump to ICD-10 fluency will be beneficial, albeit challenging. In order to study, understand and use ICD-10, healthcare organizations need to establish a learning system for their teams. The Breakaway Group, A Xerox Company, provides training for caregivers and coders that eases learning challenges, such as the expanded clinical documentation and new code set for ICD-10. Simply put, there are people can help with your entire ICD-10 travel itinerary, from creating a checklist of needs to planning a successful route.

ICD-10 is the international standard, so the journey from ICD-9 codes to ICD-10 codes will happen. Do not throw away your ICD-10 coding manuals and education materials just yet. All of these items will come in handy to reach the final destination: ICD-10.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Today is an important day in the US. The new President is inaugurated (although, technically it happened yesterday and today is just the parties). I heard one commentator say that it’s an important moment, because in many many other countries a new President isn’t met with such a peaceful event. This is one thing that sets the US apart from many other countries where Presidential inaugurations are met with riots and fighting.

I don’t really want to make this post a political post, but I’ve been watching some of the tweets coming across during the inauguration ceremonies and I thought they were interesting in the light of healthcare and the EMR world.

The image has a quote, “America’s possibilities are limitless, for we possess all the qualities that this world without boundaries demands: Youth and Drive; Diversity and Openness: an Endless Capacity for Risk and a Gift for Reinvention.”

I think it’s ironic to consider that list to healthcare. As I noted at CHIME, there was a complete lack of youth at the conference. In some ways, healthcare is very diverse and open, but in many ways healthcare IT is still the “Old Boys Club.” I don’t think anyone would define healthcare as a place of risk and reinvention. In fact, I think most would say healthcare is very risk averse and needs some reinvention.

I don’t try and point these things out as a way of being negative. Instead, I think they highlight the potential opportunity in healthcare. I think some diverse youth with drive and openness, a capacity for risk and reinvention could do phenomenal things for healthcare. It’s a great opportunity for what I heard one person today call the “Steve Jobs” of healthcare.

“Now, more than ever, we must do these things together, as one nation, and one people.” —President Obama #inaug2013

I think this quote will be pretty controversial. Although, I couldn’t help but consider it in light of the effects of EHR certification and meaningful use. I’m sure that many small EHR vendors would be happy to argue that EHR certification and meaningful use requirements did the opposite of ensuring “competition and fair play.” As hospitals continue to consolidate, it’s going to be interesting how “competition and fair play” play out in healthcare.

Those are just a few thoughts that I captured from Twitter. I’d be interested to hear your thoughts.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I know that meaningful use and the EHR incentive regulatory process has been an eye opening experience for many of us that weren’t as familiar with how the government put regulations in place. However, most hospitals are quite familiar with this process since they have been having to deal with it for a very long time.

Even with all this background and expertise, I’ve heard more and more organizations telling me that “they just can’t keep up with all of the healthcare regulations.”

Think about all of the regulations in just healthcare IT. It’s overwhelming and the healthcare IT regulations pale in comparison to many of the other regulations that hospitals must know about and follow. Plus, we’re just getting started with the fun of 5010 and ICD-10 is right around the corner.

With all of these regulations I was intrigued by a new offering from HCPro I saw during the AHIMA convention in Chicago this year. While HCPro has long been a publisher of healthcare content, they have a new product they are just launching called HCPro Comply. I think the best way to describe HCPro is a portal into every healthcare regulation imaginable. Certainly you could find all these regulations in other locations for free, but there was something beautiful about having them all available in one easily searchable place.

Plus, HCPro Comply does a lot of things to add value to the regulations they make available. For example, they chunk out sections of the regulations that really matter. I remember my shock when I heard that the Meaningful Use regulation was 692 pages. Then, as I looked at the regulation, I realized that there were really only a small number of pages in the middle that really mattered since the beginning was a bunch of overview. From what I understand, HCPro uses its clinical regulation experts to help you identify and bring out those sections of the regulation that matter most.

The other part of HCPro Comply that I found quite interesting was their “Ask An Expert” feature. While many hospitals likely have someone (or multiple people) in their organization that understand regulatory changes very well, there are always situations where it’s beneficial to get outside advice and analysis about a particularly challenging regulatory change. I’m quite familiar with meaningful use, but I’m often emailing a number of other experts to either make sure my interpretation is correct or to ask about nuances I haven’t quite figured out.

One thing that I think HCPro Comply should consider adding is allowing the experts from the various hospitals share their expertise with their colleagues. I can easily see a community of healthcare regulatory compliance experts interacting on their platform to discuss the latest regulatory changes. I’m sure that HCPro has many experts on their staff, but a network of the top hospital compliance experts would be an even more powerful offering.

Now that Obama won the Presidential campaign, ACA, HITECH and other healthcare reform are here to stay. I can see portals like HCPro Comply being a great asset in the ever changing healthcare regulatory environment.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Today is election day, and it’s definitely going to dominate the news cycle today. I figured I might as well join in. Although, if you’re looking for a partisan political post, you came to the wrong place. There will be plenty of other news outlets and blogs providing that today.

I had an interesting experience during my trip to Chicago for AHIMA. I decided to use AirBnB to find a place to stay in Chicago. I’d previously used it in San Francisco and Boston with great success. I met some really interesting people, saved some money, and had a better experience than a hotel. In San Franscisco I stayed with a guy who did the video work for Practice Fusion. In Chicago I again found that the world was small as I stayed with a guy in medical school who’s helping his friend develop an ED EMR. Of all the places and people in Chicago, how did the EMR blogger end up at the one guy who’s developing an EMR on AirBnB? How I love serendipity!

What does this have to do with the election? Well, I invited my AirBnB host to go to one of the evening events with me since he had a healthcare background. On our drive over he figured out that I was mormon and so he tactfully asked me who I was voting for in the presidential election. I tersely replied that I was dissatisfied with the whole political process and that it was a big mess of political corruption as best I could tell.

It was interesting to consider my dissatisfaction with the political process and how that applies to other areas of life. I’ve been thinking a lot more about education lately as my kids are in school. I understand the value of education and learning, but I think our schools do a terrible job of it and focus on the wrong things. I loved this video on education if you want to see what I mean.

In many ways, I have these same feelings of dissatisfaction with healthcare. I’ve often described to people the perverse incentives in healthcare that make doing what everyone knows is the right thing so difficult. At the top of this list is exchanging health information.

With all of this dissatisfaction, many might wonder how I can be so optimistic in all of these areas. I think healthcare best illustrates why we should be optimistic. If you take a look at the majority of people in healthcare, you have to be optimistic. Most healthcare people are incredibly thoughtful, caring, wonderful people that want to do their very best to provide great care. Super Storm Sandy was an incredible tragedy, but how can you not hear about the stories from NYU Lagone Medical Center and not see a caring wonderful group of devoted individuals?

Certainly we have plenty of problems in politics, education and yes healthcare. We spend far too much for the results we’re getting. However, I’m optimistic that we’re still going to do great things. There are too many great people in the world for it not to be so.

Occasionally someone will reply to one of my posts about EMR and wonder why I write something less than rosy about EMR. I think it’s valuable to tell the full story about EMR in order to make it better. Some times that means pointing out the negatives associated with EMR. Hopefully that added awareness saves a doctor from making the same mistake or that an EHR vendor improves their product based on someone’s negative experience.

At the end of the day, I’m a complete optimist when it comes to technology in healthcare. At my core I believe that technology applied properly can improve processes and improve results. Is healthcare where it should and could be with EMR? No, but I’m bullish on the long term benefits that healthcare will received from EMR use and other applications of IT in healthcare.

I’ll be keeping this optimism in mind when I go to the polling booths today. I think we often attribute too much of the results (good and bad) to the President of the US or other leaders. I think that the general population are far more powerful. That’s why I’m optimistic for the future.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I have often found doctors talking about the 2014 mandate for adoption of EHR software. In fact, this post was inspired by a bunch of people searching online for the term “2014 EHR Mandate.” I think that they found my site because I previously did this post about Obama’s goal of Full EHR adoption by 2014.

If I’m remembering right, this was actually just an extension of Bush’s goal of having 100% EHR adoption by 2014. Obama took Bush’s original EMR aspiration and kept it going.

Although, I do have a real problem with people who like to call it an EHR mandate. It’s really not a mandate. A mandate for me implies that you are required to do it or there’s some grave consequence to it. It’s not like you’re going to be thrown in jail for not using an EHR or not be able to practice medicine if you don’t use an EHR (although some have hinted at this idea). Certainly the HITECH act has provided some Medicare penalties that could be considered a grave consequence to not adopting an EHR. Although, when you consider this example of the Medicare penalties it doesn’t look all that grave of a concern to me.

What other penalties are there to not adopting an EHR by 2014?

There certainly are other potential issues with not adopting an EHR that are worth considering:
1. Ability to Sale Practice – I don’t think we know all the details of how this will play out, but be sure that many younger doctors are going to want to purchase a practice that has an EHR. The common thinking I’ve seen going around is that a practice will be more valuable if it is electronic.

2. Government Mandated Reporting – While the government can’t really mandate the use of an EHR, it seems reasonable that the government could require certain reporting be done. Of course, you could manually do this reporting, but at some point the manual way will be much harder than using an EMR where the reporting can be automated.

3. Reimbursement Requirements – At some point the insurance companies are going to require their data electronically. So, if you’re going to want to keep accepting insurance, then you’re going to need to be electronic. I think the insurance companies are still watching and waiting to see what happens with meaningful use before they decide how they’ll approach it. However, you can be sure that they want more data and electronic is the way to make that happen. Of course, you could always go back to cash pay if you don’t like it.

4. Patients – It hasn’t happened quite yet, but get ready for a new patient base that wants their doctor to be electronic. No, you won’t have a “Got EMR?” sign outside your office to market to patients like we once talked about on EMRUpdate. It will come in more subtle things like the ability to schedule an appointment online. The ability to request refill requests electronically. Not having to carry (and possibly lose) their prescription to the pharmacy and then wait for it to be filled. Not having to fill out the same paperwork over and over and over again. Once patients get a real taste for these features, they’re going to be more selective in the doctors they choose to use.

5. ROI for Your Practice – There are plenty of arguments for and against the use of an EMR from an ROI perspective. I personally side on the positive ROI side based on this list of potential EMR benefits. Certainly it takes a smart EMR selection process and a well done EMR implementation to achieve the ROI, but I know a lot of people who’ve saved a lot of money thanks to their EMR. Add in things to come like doctor liability insurance discounts and the ROI will get even better over time. I know one practice who was having tough times financially. Their implementation of an EHR helped to solve some of those financial issues.

I’m sure there are plenty of other reasons that could “force” you to move to using an EMR. Of course, this CDC study on EHR adoption says Physician EMR use is at 50%. Although, in that link I use their study to show that it’s probably closer to 25% EHR adoption. Either way, we still have a long way to go to achieve Obama’s dream of 100% EHR adoption by 2014.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I posted an EHR stimulus poll a week ago and I thought it would be interesting to post some preliminary results. I really wish a few more people would have participated in the poll. It’s only 2 clicks to add your opinion. I expect over time I’ll get some more responses.

Take a look at the current results for the question: How will your clinic be approaching the EMR Stimulus money made available in the HITECH Act (ARRA)?

What’s surprising to me from the results so far is that such a large percentage of people are either waiting to hear about the EHR stimulus money or are planning on the EHR stimulus money. This poll is a little bit biased since so many of the people visiting EMR and HIPAA these days are coming here to learn about the EHR stimulus money.

Like I’ve said before, there’s no doubt that the $18 billion investment by Obama into electronic health records has increased the interest in EHR software. We’ll have to just wait and see how much of this increased interest in EHR turns into actual EHR purchases.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

We’re all still sitting here waiting for the government to finally decide two key terms in regards to gaining access to the $18 billion in stimulus money in the HITECH act (ARRA). I’ve been interested in the subject myself since before it was even settled that we’d call it meaningful use as opposed to meaningful EMR user. From the looks of that post back in February, there was still a lot of confusion about “meaningful use” and “certified EHR.”

Turns out that a few months later, we still have very little clarification about what these two terms mean. Certified EHR discussion has really revolved around CCHIT certification or some other alternative. We’ll try to leave that discussion for other posts. What has been interesting is in just the past week or two there has been a literal flood of people offering their perspective on meaningful use. Sometimes I like to be on the cutting edge of these definitions (like I was in the link above) and other times I like to sit back and let them play out. This time I’ve been letting it play out and it’s really interesting to see the multitude of perspectives.

I’m not planning on writing my own plan for how they should do meaningful use. I may do that at a later time if so inclined. For now, I’ll just focus on highlighting points from what other people have suggested and provide commentary that will hopefully enhance people’s understanding of this complicated mandate (yes, that means this post will be quite long).

I think it’s reasonable to first point you to the NCVHS hearing on “Meaningful Use” of Health Information Technology. This matters, because at the end of the days hearings like these are where most of the information are going to come. Then, with the information from these hearing decisions will be made. The other sources like blogs won’t carry nearly as much weight (although it’s unfortunate that more politicians aren’t listening).

John Chilmark on Meaningful Use
Next, I’ll go to one of my newly found favorite bloggers named John Chilmark (any coincidence we’re both named John). John from Chilmark Research commented that HHS is bringing together the “usual suspects” to discuss “meaningful use. Chilmark also states that the following criteria are what’s required for meaningful use:

Electronic Prescribing

Quality Metrics Reporting

Care Coordination

I’m not sure where he got this list, but this list feels kind of weak if you ask me. In fact, John suggests that these requirements will be simple and straightforward and first and then ratcheted-up in future years. Interesting idea to consider. I hope that they do draft the requirements for meaningful use in a way that it can be changed in the future if it turns out to not be producing the results it should be producing.

John Halamka on Meaningful Use
Next up, the famous John (another John) Halamka, Chief of every Health IT thing (at least in Boston), calls defining “meaningful use” “the most critical decision points of the new administration’s healthcare IT efforts.” He’s dead on here. In fact, it might not be the most critical decision for healthcare IT, but for healthcare in general as well. Here’s John Halamka’s prediction for how “meaningful use” will be defined:

My prediction of meaningful use is that it will focus on quality and efficiency. It will require electronic exchange of quality measures including process and outcome metrics. It will require coordination of care through the transmission of clinical summaries. It will require decision support driven medication management with comprehensive eRx implementation (eligibility, formulary, history, drug/drug interaction, routing, refills).

Basically, he’s predicting inter operable EMR software and ePrescribing with a little decision support sprinkled on top. I won’t be surprised if this is close to the final definition. The only thing missing is the reporting that will be required to the government. The government needs this data to fix Medicare and Medicaid (more on that in another post).

Blumenthal Comment to Government Health IT
Government Health IT has a nice quote from David Blumenthal that says: “The forthcoming definition of the “meaningful use” of health information technology will set the direction of the Obama administration’s strategy for health IT adoption, said David Blumenthal, the new national coordinator for health IT.”

I think there’s little doubt that David Blumenthal has a good idea of the importance of the decisions ahead. What should be interesting is to see how involved Obama is in these very important decisions. I’m guessing Obama won’t do much more than sign a paper to make it happen. I just hope I’m wrong.

HIMSS Definition of Meaningful Use
Here’s a short summary of the HIMSS definition of “meaningful use”

According to HIMSS officials, EHR technology is “meaningful” when it has capabilities including e-prescribing, exchanging electronic health information to improve the quality of care, having the capacity to provide clinical decision support to support practitioner order entry and submitting clinical quality measures – and other measures – as selected by the Secretary of Health and Human Services.

Basically, e-prescribing, interoperability and clinical decision support. Turns out a BNET Healthcare article suggested the same conclusion “The consensus of physician and industry representatives was that meaningful use should include interoperability, the ability to report standard quality measures, and advanced clinical decision-making.”

I think we’re starting to see a bit of a pattern here. I should say that these are all very good things, but the challenge I see is that any requirement needs to be easily and consistently measured. Interoperability and clinical decision support are both very difficult to measure. Just wait until they see the variety of software that tries to do those two things. It’s very difficult to measure it consistently across so many EHR software.

Wow!! I barely even got started on this subject. Instead of belaboring the point, let me just point you to some other interesting readings about the HITECH Act, ARRA, and “meaningful use.”

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I may have missed this somewhere else, but today was the first time I have found one of the major newspapers actually talk about EHR certification possibly being worse than what a competitive EHR marketplace can produce.

You can read the Wall Street Journal opinion article to see what I mean. Here’s the conclusion which describes the problem with certified EHR:

The stimulus hands the Obama Administration the power to define and approve “certified” records, therefore the power to create a health-tech monopoly. With stimulus money being shoveled out as quickly as possible, doctors and hospitals may end up prematurely investing in the costly systems that happen to have the government seal of approval — and in the process freezing out an innovative marketplace.

Granted, this was just in the opinion section of the Wall Street Journal, but I think more people need to stand up and make this opinion known. If you think we have problems now imagine what will happen when the government becomes the “arbiter of health information technology.”

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’ve been really amazed at the number of people I’ve heard talking about the HITECH Act bringing in a “new age of EHR” and other similar phrases. Then, I usually consider who’s been saying it and I realize that their pocketbooks are going to be lined with money from the HITECH Act and EHR adoption. So, I take it with a grain of salt.

Instead, I like to look at examples to help me better understand what might happen with the $18 billion Obama’s planning to spend on EHR adoption. The best example I know of comes from the British National Health System. It’s certainly not a perfect match, but should open our eyes on government funded EHR systems.

Britain’s NHS, who have been trying to get their HIT system to work properly for the past 5 years. The cost of NHS’ HIT has escalated to 6 times the original estimate — the U.S. equivalent of $18.4 billion — to serve just 30,000 physicians in 300 state-run hospitals, a fraction of the health care providers in the USA.

HIT is such a mess that Leigh recommended funding alternative systems if matters don’t improve within the next 6 months.

A large 2003-04 study of 1.8 billion ambulatory patients discovered that the use of electronic health records provided no difference in 14 of 17 quality-care indicators, produced significantly better care in just two and worse care in one.

And, a summary of 33 studies done in Europe between 1985 and 2009 found that HIT actually causes a significant number of medical errors.

Definitely cause for concern since Britain has spent $18.4 billion on a MUCH smaller health care system. Looks like Obama should have applied his “down payment” principle to HITECH Act’s $18 billion towards EHR too.

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